早期应用无创正压通气在撤机相关性肺水肿患者的临床研究

Clinical Study of Early Application of Noninvasive Positive Pressure Ventilation in Patients with Weaning Induced Pulmonary Edema

目的探讨早期应用无创正压通气对于呼吸衰竭合并心功能不全患者撤机相关性肺水肿(WIPE)的随机对照临床研究。方法纳入我科呼吸衰竭合并心功能不全机械通气患者107例,将纳入的患者采用随机数字表法分组,撤机后试验组接受无创正压通气(n=54),对照组接受高流量氧疗通气(n=53)。记录两组患者撤机4 h后心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、低氧血症、48 h再次气管插管、患者氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2))、氧饱和度(SaO_(2))等指标,同时比较两组患者住重症监护病房(ICU)时长及住院时长、气管切开、28 d住院病死率及并发症等情况。结果无创正压通气组患者HR、RR显著低于高流量氧疗组(P=0.028、0.018),MAP较高流量氧疗组高(P=0.047),低氧血症、48 h再次插管发生率显著低于高流量氧疗组(P=0.031、0.038),患者PaO_(2)、PaCO_(2)、PaO_(2)/FiO_(2)、SaO2等指标均优于高流量氧疗组(P<0.001),无创正压通气组患者在ICU时长及住院时长方面明显短于高流量氧疗组(P<0.001、P=0.005),28 d住院病死率低于高流量氧疗组(P=0.029),而两组在气管切开、并发症等方面差异无统计学意义(P=0.076、0.896、0.984)。结论早期应用无创正压通气可降低呼吸衰竭合并心功能不全患者WIPE的发生,避免低氧血症发生,降低患者48 h再次气管插管率,缩短患者的住院时长。

Objective To investigate randomized controlled clinical effects of initial noninvasive positive pressure ventilation on weaning related pulmonary edema(WIPE)in patients with respiratory failure and cardiac insufficiency.Methods 107 patients with respiratory failure and cardiac insufficiency were registered in our department.Patients were randomly divided into two groups by a random number table.After weaning,test group received noninvasive positive pressure ventilation(n=54),and control group received high flow oxygen therapy(n=53).Heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP),hypoxemia,48 h tracheal intubation,patient partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(PaO_(2)/FiO_(2)),oxygen saturation(SaO_(2))and other indicators were recorded at 4 h after weaning.At the same time,length of stay in ICU,length of hospitalization,tracheotomy,mortality and complications of 28 days of hospitalization were compared.Results HR and RR were significantly lower in the noninvasive positive pressure ventilation group than those in the high flow oxygen therapy group(P=0.028,0.018),higher in MAP than those in the high flow oxygen therapy group(P=0.047),and the incidence of hypoxemia and reintubation within 48 hours was significantly lower than those in the high flow oxygen therapy group(P=0.031,0.038).PaO_(2),PaCO_(2),PaO_(2)/FiO_(2),SaO_(2) and other indicators were better than those in the high flow oxygen therapy group(P<0.001,P=0.005).The length of stay in ICU and hospitalization in the non-invasive positive pressure ventilation group was significantly shorter than that in the high flow oxygen therapy group(P<0.001).The in-hospital mortality of 28 days was less than that of the high flow oxygen therapy group(P=0.029),but there was no difference in tracheotomy and complications(P=0.076,0.896,0.984).Conclusion Early application of noninvasive positive pressure ventilation could reduce the occurrence of meaning related to pulmonary edema in patients with respiratory failure and cardiac insufficiency,avoid the occurrence of hypoxemia,reduce the rate of re intubation in 48 hours,and shorten the length of hospitalization.